Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia

Health Policy Plan. 2004 Jul;19(4):199-208. doi: 10.1093/heapol/czh025.


Growing evidence has demonstrated that informal fees for health services comprise a large proportion of total health spending in some countries. In 1999, individual out-of-pocket payments for health in Cambodia were estimated at 27 US dollars per person, with a proportion paid as under-the-table fees at public facilities. By formalizing such payments and implementing resource management systems within a comprehensive health financing scheme, Takeo Referral Hospital controlled out-of-pocket patient expenditures, ensured patients of fixed prices, protected patients from the unpredictability of hospital fees and promoted financial sustainability. Utilization levels increased by more than 50% for inpatient and surgical services, and cost recovery from user fees averaged 33%. Furthermore, the hospital phased out external donor support gradually over 4 years and achieved financial sustainability.

MeSH terms

  • Cambodia
  • Cost Control*
  • Financing, Personal*
  • Health Expenditures*
  • Hospital Costs*
  • Reimbursement Mechanisms*